Key result
Spinal anesthetic failure occurred in 3.8% of cases, with higher odds for hip vs knee arthroplasty (OR 1.90), L5-S1 vs L2-3 insertion (OR 7.66), and 22-gauge vs 25-gauge needles (OR 2.17).
Why the study?
What factors are associated with the failure of spinal anesthetic in patients undergoing elective hip and knee joint arthroplasty?
Observational (n=3,542)
What factors are associated with the failure of spinal anesthetic in patients undergoing elective hip and knee joint arthroplasty?
Odds Ratio: 1.9 (95% CI 1.28–2.84)
Failure of spinal anesthesia in joint arthroplasty is associated with specific patient and procedural factors, including younger age, lower BMI, hip surgery, lower lumbar insertion, larger needle size, and hyperbaric bupivacaine.
Associated factors may inform SA planning in arthroplasty; hypothesis-generating pending prospective validation.
The primary outcome of this 8-year retrospective review was the failure of spinal anesthetic (SA) in elective hip and knee joint arthroplasty surgery. Of 3542 SAs, a total of 135 failures were identified (3.8%). Factors associated with increased odds of failure were younger age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05), lower body mass index (BMI; OR, 1.04 [1.01-1.08]), hip arthroplasty (OR, 1.90 [1.28-2.84]) compared to knee arthroplasty, needle insertion at L4-5 (OR, 4.61 [2.02-10.54]) and L5-S1 (OR, 7.66 [2.47-23.7]) compared to L2-3, 22-gauge needle size (OR, 2.17 [1.34-3.52]) compared to 25-gauge needle, and hyperbaric bupivacaine (OR, 1.66 [1.09-2.53]) compared to isobaric bupivacaine.
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Colish et al. (2019) conducted an observational in Elective hip and knee joint arthroplasty (n=3,542). Hip arthroplasty (and other patient/procedural factors) vs. Knee arthroplasty was evaluated on Failure of spinal anesthetic (SA) (OR 1.90, 95% CI 1.28-2.84). Spinal anesthetic failure occurred in 3.8% of cases, with higher odds for hip vs knee arthroplasty (OR 1.90), L5-S1 vs L2-3 insertion (OR 7.66), and 22-gauge vs 25-gauge needles (OR 2.17).
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